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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191570895
Report Date: 05/07/2025
Date Signed: 05/07/2025 03:18:23 PM

Document Has Been Signed on 05/07/2025 03:18 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:LINDBERGH FULL DAYFACILITY NUMBER:
191570895
ADMINISTRATOR/
DIRECTOR:		VERONICA BLOOMFIELDFACILITY TYPE:
850
ADDRESS:12120 LINDBERGH ROADTELEPHONE:
(310) 631-7308
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY: 73TOTAL ENROLLED CHILDREN: 73CENSUS: 36DATE:
05/07/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:31 PM
MET WITH:Courtney Gillette-Early Childhood Education (ECE) CoordinatorTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced case management inspection at the facility to follow up on three unusual incident reports (UIRs) that were submitted to the Department. LPA met with Courtney Gillette-ECE Coordinator and explained the reason for the visit. LPA observed 16 children with 3 staff in Room 14 and 22 children with 3 staff in room T-11.
One UIR reported on 4/10/25 was regarding a child who wandered away from the classroom for a few minutes. Per the report and per interviews conducted today, Room 14 was outside for outdoor play. It was time for the class to transition to have a drink of water when Staff 1 noticed Child 1 was not with the group. Per interviews, Staff 1 asked the other staff if they had seen Child 1 to which they answered no. After about 2-3 minutes Child 1 was found to be in the main Child Development office with Education Specialist, Gisele Ochoa.
The second UIR occurred on 4/30/25 and was reported on 5/1/25. Child 2 was participating in an outdoor activity. They fell from one of the cushioned platforms on the obstacle course and appears to have fallen on their face on the surface below. Per staff interviews, Staff 2 assisted the child immediately and took them to the restroom to clean up the wounds on their forehead, nose and lips. Child 2 was taken to the nurse's office and the authorized representative was contacted within a few minutes. Parent was advised to take child to seek medical attention but there has been no follow up provided.
The third UIR occurred on 5/5/25 and was reported on 5/6/25. This incident also involved a child who wandered away from the classroom for a few minutes. Per the report and per staff interviews, Child 3 was confirmed to have been inside the classroom and managed to exit the classroom during a transition from one activity to another. Per interviews, Child 3 was observed outside the classroom by another staff who then took the child to the main CDC office.
NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Jeanette Estrada
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LINDBERGH FULL DAY
FACILITY NUMBER: 191570895
VISIT DATE: 05/07/2025
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Education Specialist, Gisele Ochoa then took Child 3 back to the classroom where the staff had not been aware that they were missing from the classroom. Per staff interviews, there must have been a lapse of about 5 minutes from the time the child was seen in the classroom and when he was returned from outside.

Based on interviews, the UIRs regarding lack of supervision and Child 1 and Child 3 wandering away from the classroom are being cited today. The incident regarding the injury needs further investigation.

LPA informed Facility Representative that this report dated 5/7/25 documents one (1) type A citation which will be posted for 30 consecutive days as there are immediate risks to the safety of children in care.

LPA also informed Facility Representative to provide a copy of this licensing report dated 5/7/25 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with the facility representative Courtney Gillette ECE Coordinator

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Jeanette Estrada
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/07/2025 03:18 PM - It Cannot Be Edited


Created By: Jeanette Estrada On 05/07/2025 at 02:51 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LINDBERGH FULL DAY
FACILITY NUMBER: 191570895

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/08/2025
Section Cited
CCR
101229(a)(1)

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101229(a)The licensee shall provide care and supervision as necessary to meet the children's needs.(1) No child(ren) shall be left without the supervision of a teacher at any time..This requirement is not met as evidenced by
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Per Facility Representative (FR), staff will attend an in depth training on active supervision and different strategies for supervision. FR will provide agenda by due date 5/8/25 and will follow up with proof of attendance by staff by 5/16/25
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Based on record review and interview Child 1 and Child 3 were left without supervision as they managed to wander away from the classroom on two separate occassions. This poses an immediate risk to the safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Warren Birks
NAME OF LICENSING PROGRAM MANAGER:
Jeanette Estrada
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/07/2025


LIC809 (FAS) - (06/04)
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